Kalpa Sthana

Kalpa Sthana deals with the study of formulations used in therapeutic purification procedures.

Charak Samhita Kalpa Sthana

Sections
Preceding	Chikitsa Sthana
Succeeding	Siddhi Sthana
All Sections	Sutra Sthana,Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Chapters
Madanakalpa Adhyaya, Jimutaka Kalpa Adhyaya, Ikshvaku Kalpa Adhyaya, Dhamargava Kalpa Adhyaya, Vatsaka Kalpa Adhyaya, Kritavedhana Kalpa Adhyaya, Shyamatrivrita Kalpa Adhyaya, Chaturangula Kalpa Adhyaya, Tilvaka Kalpa Adhyaya, Sudha Kalpa Adhyaya, Saptalashankhini Kalpa Adhyaya, Dantidravanti Kalpa Adhyaya

Preamble of Kalpa Sthana

A healthy individual is an asset to any society (and contributes to making a healthy society), while a sick individual will be a liability to his family in particular and the society at large. To keep oneself healthy, Ayurveda lays down the principles of various lifestyles in terms of daily regimen (dinacharya), seasonal regimen (ritucharya) and modified lifestyles to cure the diseases. Physical exercise for the preservation of health begins with adapting techniques for purification of the body and the mind along with an intake of rasayana drugs (rejuvenatives). Accumulated malas (metabolic waste) at the level of cell, tissue or organ should be expunged out to facilitate the restoration of normal functioning of the body by five purificatory procedures (shodhana karma) often referred as Panchakarma, namely vamana (emesis), virechana (purgation), asthapana basti (evacuative enema), anuvasana basti (restorative enema), and shirovirechana (errhines) are indicated for healthy as well as diseased persons. If malas are not taken out of the body, they cause diseases and decay (ageing) of the body. After purification procedures, jatharagni (gastro-intestinal digestive juices) becomes weak and may not digest the food normally. For restoration of this function, the food that is easily digestible is introduced and increased gradually over a period of time and this procedure is called samsarjana karma. Details of pharmaceutical process of drugs employed in vamana and virechana procedures are given in this section and detailed therapeutic implications of all the shodhana karma in Siddhi Sthana.

Vamana and virechana therapies should be administered before administering basti (medicated enema therapy). Therefore, vamana and virechana drugs are first described in Kalpa Sthana before the description of basti therapy, which is described in detail under Siddhi Sthana. Generally, purgation therapy is administered only after the administration of emetic therapy and keeping this view the first six chapters are allocated for description of emetic drugs.

Six drugs have been described for emesis and nine others are described for purgation. Six hundred recipes prepared from these drugs (Total 15 drugs) are for the use of physician of low caliber and intelligent physician can formulate many other recipes to suit the exact requirement of his patient. The formulations are prescribed according to disease in different dosage forms like kashaya (decoction), svarasa (juice), kalka (paste), churna (powder), peya (drinks), lehya (lickable), and bhojya (foods).

Kalpa Sthana Contents at a glance

Chapter No.	Chapter Name	No. of Shlokas	Name of the drug	No. of Recipes	Part Used	Botanical identification
1	Madanakalpa Adhyaya	30	Madanaphala	133	Fruit and Flower	Randia dumetorum
2	Jimutaka Kalpa Adhyaya	15	Jimutaka	39	Fruit and Flower	Luffa echinata Roxb.
3	Ikshvaku Kalpa Adhyaya	23	Ikshvaku	45	Leaf, Fruit, Seed	Lagenaria siceraria Standl.
4	Dhamargava Kalpa Adhyaya	20	Dhamargava	60	Fruit, Flower, Tender Leaves	Luffa cylindrica (Linn.) M. Roem.
5	Vatsaka Kalpa Adhyaya	13	Vatsaka	18	Fruit	Holarrhena antidysenterica Wall.(male Kutaja)and Wrightia tinctoria R.Br.(or W. tomentosa Roem. & Schult.)(female Kutaja)
6	Kritavedhana Kalpa Adhyaya	14	Kritavedhana	60	Flower, Fruit	Luffa acutangula (Linn.)
7	Shyamatrivrita Kalpa Adhyaya	80	Shyama, Trivrita	110	Root	Ipomoea petaloidea Chois.(Shyama trivrita),Operculina turpethum (Arun trivrita)
8	Chaturangula Kalpa Adhyaya	18	Araghvadha	12	Fruit	Cassia fistula Linn.
9	Tilvaka Kalpa Adhyaya	18	Tilvaka	16	Root, Bark	Viburnum nervosum(According to Thakur Balavant Singh)
10	Sudha Kalpa Adhyaya	22	Sudha	20	Milky Latex	Euphorbia neriifolia Linn.
11	Saptalashankhini Kalpa Adhyaya	19	Saptala, Shankhini	36	Root (of Saptala), Fruit (of Shankhini)	Euphorbia dracunculoides Lam. and Colonyction muricatum G Don.
12	Dantidravanti Kalpa Adhyaya	107	Danti, Dravanti	49	Root	Baliospermum montanum Muell.-Arg.
Total		379		600

Madanakalpa Adhyaya (pharmaceutical preparations)is the very first chapter of Kalpa Sthana of Charak Samhita. In all, there are twelve chapters in this section, of which the first six including Madanakalpa describe the various pharmaceutical formulations for emesis while the remaining six describe various purgative pharmaceutical preparations. Each chapter is named after a plant drug and in every chapter many compound formulations with suitable plant drugs are also given. Grossly, all twelve chapters can be divided into Vamana and Virechana Kalpa. The literal meaning of Vamana is to eliminate the doshas(impurities) from gastro-oral route whereas from lower tract- through anus it is known as purgative. Since impurities are eliminated in both the cases, it is known as Virechana sanjna (evacuative)(Cha.Ka.1/4)

Salient features of Kalpa Sthana

Charak detailed the Pharmacokinetics of drugs, dosage forms and weights and measures in this section. Drugs useful for vamana and virechana are discussed with their synonyms, varieties, pharmacological actions, and various modes of application in different dosage forms.

Factors responsible for therapeutic efficacy

Four important factors for producing maximum therapeutic efficacy of these drugs are identified. Deshasampat (collecting the plant from appropriate habitat), kalasampat (collecting the drugs in the appropriate season), gunasampat (collecting the plants when they are enriched with excellent attributes like rasa, guna, virya, etc.) and bhajanasampat (storage of drugs in appropriate container).

Pharmacokinetics of Drugs

Drugs (used for emesis and purgation) which are ushna (hot), tikshna (sharp), sukshma (subtle), vyavayi (those pervading the entire body before getting digested) and vikasi (those causing looseness of joints), by virtue of their own potency, reach the heart and circulate through the vessels. Because of their agneya nature (predominance of agni mahabhuta, or fire element), they liquefy the compact form of (adhered) doshas (morbid material), and because of their sharpness (tikshna attribute) they separate the adhered doshas located in the gross and subtle channels of the entire body. Like honey kept in the pot smeared with fat, the morbid material, after separation, moves floating without adhesion in the body which has been oleated (by the administration of oleation therapy). Because of its nature to move through subtle channels and to flow (towards the gastrointestinal tract), this morbid material reaches the stomach, and gets propelled by udana vayu. Because of the predominance of agni and vayu mahabhutas in these (emetic) drugs, and because of their specific action to move upwards, the morbid material gets expelled through the upward tract (mouth). On the other hand, purgative drugs, because of the predominance of prithvi and jala mahabhutas, and because of their specific action, (prabhavajanya) move downwards to expel the morbid material through the downward tract (anus). Combination of both these attributes result in the expulsion of the morbid material through both the upward and downward tracts.

Similarities/ Dissimilarities of virya

Sometimes, the drugs of secondary nature (mixed with main drug) have antagonistic property. Even then they do not contradict the effects of the principal drug. If these drugs of secondary nature are similar in potency as that of the principal drugs, then the recipe becomes all the more effective therapeutically. Trituration, boiling etc. are considered samskaras which bring in chemical changes in the chemical structure of the drug resulting in the modification of the drug activity.

Modification of drug activity

Ingredients of a recipe should be impregnated with the juice or decoction of other ingredients having identical potency. By virtue of appropriate samyoga (addition of ingredients), vishlesha (elimination of ingredients), kala (appropriate time of administration) and samskara (processing) even a small quantity of a drug may produce more powerful effects, and otherwise even a recipe in large quantity may produce very mild effects.

Weight and measures

Two traditions for mana (weight and measures) are mentioned in Kalpa Sthana, namely, Kalinga (part of present Orissa) and Magadha (part of present Bihar). Charak opines that Magadha is better than former. Chakrapani considers this statement as unauthentic. It is also suggested that when weight of ingredients in a recipe is not specified, then all the ingredients are to be taken in equal quantity.

Snehapaka (Dosage form)

Charak Samhita does not specify the liquid medium to be used in formulation of the medications. However, the use of certain liquids has been known through practice and other sources. In the process of snehakalpana, for example, water has to be used invariably. Snehapaka (preparation of medicated oil or ghee) is categorized into three types i.e. mridupaka (mild boiling), madhayamapaka (moderate boiling) and kharapaka (full boiling). Sneha processed by kharapaka is indicated for massage purpose, mridupaka sneha is recommended to be used for nasya (inhalation) and moderately processed oil or ghee for internal use including for basti karma.

Purification of drugs

To reduce the toxicity (vikasi guna) of Danti and Dravanti, Charak evolved a process using Pippali and honey paste which is to be besmeared over the roots and once again to be smeared with mud and fomented with steam after drying up in sun. Chakrapani observes that heat of fire and sunrays makes the root free from adverse effects. This could be quoted as a best example of purification process employed for the removal of toxicity - a novel concept mentioned by Charak. In the medieval ages, Rasashastra texts adopted several purificatory procedures for various herbal and metallic drugs.

Sushruta's perspective of Kalpa sthana

The subject matter of Kalpasthana in Sushruta samhita is entirely different and deals with one of the Ashtangas of Ayurveda known as Damshtrachikitsa (Toxicology). Sushruta furnished the details of vamana and virechana drugs in Sutra sthana (43 and 44th chapter). Among vamana dravyas madanaphala, jimutaka pushpa, kutaja phala, ikshvaku pushpa, kritavedhana beeja and dhamargava phala are enumerated. Sushruta identified best virechaneeya drugs based on part used like, trivrit among root purgatives and amongst bark, fruits, oil, juice and latex, the drugs namely tilvaka, haritaki, erandataila (Castor oil), karavellaka and snuhi are considered as best respectively. Trivrit, danti, dravanti, tilvaka, haritaki, chaturangula, erandataila, snuhiksheera, saptala, and shankhini are enumerated under virechaneeya drugs. There is not much difference among the drugs enumerated in Charak and Sushruta, but Sushruta included triphala, erandataila under virechana drugs.

Charak suggested root bark of tilvaka while Sushruta instructed to use bark of tilvaka. A purgative recipe is suggested for children, old people, delicate and patients suffering from dhatukshaya (weight loss/wasting condition) by Sushruta which includes erandataila (Castor oil) mixed with triphala kwatha and milk or meat soup. He also suggested chaturangula for children up to age 12. It appears that Sushruta suggested easily available purgatives.

Relevance of the concepts of Kalpa Sthana in the current clinical practices

Vamana karma (emesis) and virechana karma (purgation) are mandatory before performing basti karma (enema), in order to promote health (i.e., for the patient to gain weight). Keeping this in view, the details about drugs employed in vamana and virechana karma are described in this section and the details about basti karma in the subsequent section, Siddhi Sthana.

For vamana karma, Madanaphala is the main drug employed in the current clinical practice. But the rest of five drugs (i.e., Jimutaka, Ikshvaku, Dhamargava, Vatsaka, and Kritavedhana) are not being prescribed. Charak suggested the period of collection and procedure for extracting seed from the Madanaphala. These procedures are not being followed currently.

In the purgative therapy the drug Trivrita is prescribed currently in the various dosage forms and Aragwadha and Danti are infrequently prescribed. Charak suggested a procedure for extracting the pulp from the fruit of Aragwada. He also described a process to reduce vikasi guna (causes looseness of tissues) of Danti root. Both these procedures are not in vogue. Sushruta suggested Triphala (three fruits, namely Haritaki, Vibitaka, and Amalaki) and Eranda Taila (Castor oil) as purgatives and are prescribed in the current clinical practice.

Tilvaka, Saptala, Sankhini, and Dravanti are the purgative drugs suggested by Charak which are controversial and not being preferred in current practice.

The procedures described by Charak with regard to vamana and virechana karma are being followed religiously by Ayurvedic physicians of current times.

Ayurvedic classics have advocated to collect the medicinal plants according to part used and seasons in order to get desired pharmacological action and therapeutic benefits. Sushruta, Charak and other acharyas advocate the collection of various parts of medicinal plants based on the seasons. The logic behind such recommendations has been validated by recent modern scientific research.

In a study the variations in the phytoconstituents of Ashwagandha root was evaluated according to lunar cycles with regard to grishma and shishira ritu (summer and late winter season). In this study, total phenolic, flavonide and carbohydrate content of Ashwagandha root were found more in poornima (full moon day) samples. GAP (Grishma Ashadha Poornima, or the full moon night occurring in the Grishma-Ashadha season) samples showed maximum differentiation from rest of the samples with regards to TCA, TCW, TFW, MEx, WEX, pH etc. parameters. The Grishma-Jyeshtha Poornima (GJP) and GAP samples were found to be superior than Amavasya (new moon day) samples with regard to functional groups and with anoloid content respectively. Such type of studies validate the concept of seasonal collection of drug delineated in Ayurveda classics like Charak Samhita and Sushruta Samhita.

Contemporary perspective

Modern phytochemistry suggests that Saponin containing drugs act like irritants due to their foam producing action. Through this mechanism, drugs like madana, ikshvaku, jimutaka, kritvedhana may produce emesis. Till date there is no research work carried out on biological activity of kurchine regarding emesis. Drugs containing anthroquinone derivatives tend to be good laxatives. Therefore anthraqinone containing drugs like argvadha act as good virechaka drugs. Ayurvedic classical texts atributed anti-diarrhoel activity to kutaja (Stem bark & seeds). Charak included kutaja under emetics. It may be interpreted that kutaja in emetic doses induces vomiting, while in sub-emetic or therapeutic doses controls diarrhea. According to modern pharmacology “the emetic drugs in sub-emetic doses acts as bronchodilators” indicates that alteration of the dose of the drug can produce different pharmacological actions. It can be presumed that kutaja in emetic doses produces vomiting at the level of upper gastrointestinal tract, while the therapeutic dose of the drug controls diarrhea at the level of lower gastrointestinal tract. Vamanopaga drugs (synergistic drugs to vamana karma) like kovidara, karbudara, shanapushpi, pratyakpushpi possess agni and vayu mahabhuta dominance can support main vamana dravya for emetic action, while drugs like draksha, kashmariphala, parushaka, badara, kuvala, peelu, karkandhu are prithvi and ap mahabhuta dominant drugs, which can support the main virechaka drugs for inducing purgative action.

To summarize the content of Kalpa sthana of Charak samhita it appears that the information about most popular emetic and purgative drugs with various dosage forms is furnished. And more research is required to explain modus operandii of emetic and purgative drugs and their therapeutic applicability through evidence based clinical trials which were in vogue during those times.

Important concepts in Kalpa Sthana

• Mode of action of Vamana and Virechana (Chapter 1 Verse 5)
• Factors responsible for potency of drug (Chapter 1 verse 7)
• Selection of soil and desha classification for collecting good quality medicinal plants (Chapter 1 verse 7-8)
• Ideal and forbidden areas for collecting medicinal plants (Chapter 1 verse 9)
• Time period of collection and harvesting herbs (Chapter 1 verse 10)
• Storage of herbs (Chapter 1 verse 11)
• Concept of Anupana (vehicle) (Chapter 1 verse 12)
• Nasal drug delivery of herbs (Chapter 1 verse 19, Chapter 3 verses 11-12, Chapter 4 verse 10, Chapter 10 verse 17)
• Concept of ascending dosage schedule (vardhamana matra) (Chapter 3 verse 13)
• Development of different dosage forms of purgatives according to constitution (Chapter 7 verse 28)
• Formulation of purgative drugs according to seasons (Chapter 7 verse 56 and 59)
• Formulation designing according to koshtha(Chapter 10 verse 17)
• Principles of indicating nomenclature of formulation (Chapter 12 verse 44)
• Concept of potentiation of drugs including the theory of antogonism and synergism (Chapter 12 verse 45-48)
• Categorization or classification of therapeutic response into mild, moderate and severe categories (Chapter 12 verse 50-56)
• Importance of assessment of roga bala and rogi bala ( severity of disease and strength of patient) for prescribing purification procedures(Chapter 12 verse 60)
• Management of residual dosha with food and medicated decoctions after purification therapies (Chapter 12 verse 66)
• Concept of examination of koshtha (status of gastrointestinal tract) while administering vamana and virechana drugs (Chapter 12 verse 67)
• Concept of sneha and ruksha virechana (Chapter 12 verse 82-83)
• Inhibiting factors fro prevention of purgative actions (Chapter 12 verse 80)
• Concept of posology based upon koshtha(status of gastro intestinal tract), vaya(age) and bala(strength) (Chapter 12 verse 86)

Important areas of research and its clinical applications

• Standardization of procedure of vamana and virechana karma
• Standardization of processes of different dosage forms
• Studies on procedures and processing of different anupana like Kwatha, Yavagu, Ksheerapaka, Swarasa, Shashkuli, Shadava, Raga, Shukta, Suramanda, Asava, Sura, Varit, Krishara, Panaka, Sauvira, Tushodaka, Avaleha, Shritapaka, Seedhu, Utkarika